Provider Demographics
NPI:1952660227
Name:WILLIAMS, PHONEMANY MARY (LPN)
Entity Type:Individual
Prefix:
First Name:PHONEMANY
Middle Name:MARY
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 E. SAGEBRUSH ST.
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340
Mailing Address - Country:US
Mailing Address - Phone:623-541-1418
Mailing Address - Fax:623-547-1947
Practice Address - Street 1:272 E SAGEBRUSH ST
Practice Address - Street 2:
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-4934
Practice Address - Country:US
Practice Address - Phone:623-541-1418
Practice Address - Fax:623-547-1947
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-08
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP043653164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse